The role of parenteral nutrition following surgery for duodenal atresia or stenosis
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- Bishay, M., Lakshminarayanan, B., Arnaud, A. et al. Pediatr Surg Int (2013) 29: 191. doi:10.1007/s00383-012-3200-9
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In our institution, some children routinely receive parenteral nutrition (PN) following surgery for duodenal atresia/stenosis, while others do not. Our aim was to compare growth and infection rate between these two treatment strategies.
This was a retrospective study of all children undergoing surgery for duodenal atresia/stenosis over 7 years.
Of the 54 children, 19 commenced PN soon after surgery (the ‘Initial PN’ group). Of the remaining 35 children, 13 (37 %) subsequently required PN (the ‘Delayed PN’ group). The remaining 22 never received PN (the ‘Never PN’ group). The proportion of patients experiencing clinically suspected sepsis was higher in those receiving PN (‘Initial’ plus ‘Delayed’; 41 %) compared with those who never received PN (14 %; p = 0.04). The ‘Initial PN’ and ‘Never PN’ groups did not show a significant change in weight Z score over time. However, the ‘Delayed PN’ group showed a significant decrease in weight Z scores from the time of operation to the time of achieving full enteral feeds, and failed to catch up by the time of last follow-up.
Children with duodenal atresia/stenosis can be managed without PN. However, a third of these children subsequently require PN, lose weight centiles, and have a high rate of sepsis.